NPI | 1619128634 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60680701) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA SC60113634) |
101YM0800X Counselor, Mental Health (Licence: WA LW60296750) | |
Enumeration Date | 2008-10-08 |
Last Update Date | 2016-09-02 |